PENATALAKSANAAN
Upper Airway Obstruction (Obstruksi saluran Nafas Atas)
- Nose: hypertrophy concha,polyp- Nasopharynx- Oropharynx- Larynx
Upper Airways System
Anatomi (tonsil-adenoid)
Anatomy of Normal Larynx
Upper Airways Obstruction : Laryngeal obstruction, one of emergency
condition in ENT field
Hypoxia Apnea
DeathDeath
Clinical Features- Stridor- Airway obstruction, partial or severe- Repeated aspiration- Cyanotic or apnoeic attacks- Husky, weak or absent cry in infants- Husky voice in older children and adult- Atypical ‘pneumonia’ or ‘bronchitis’- Inhaled or ingested foreign body
Jackson Clasification 4 stadium
Stadium 1 : - Mild suprasternal retraction in inspiration - Inspiration stridor
Stadium 2 : - Deep suprasternal + epigastrium retraction - Restlessness - Inpiration stridor
Jackson Clasification (cont..)
Stadium 3 : - Suprasternal + epigastium + supraclavicula + intercostal retraction - Restlessness and dyspnea - Inspiratory + expiratory stridor
Stadium 4 : - Deep retraction, fatique - Cyanosis asfixia, apnea
Cause :1. Congenital abnormality : - laryngomalacia - congenital web
- stenosis subglotic
Choanal Atresia
2. Foreign body : - FB Rima glotis, subglotis, trachea
3. Infection/Inflamation : - laryngitis, epiglotitis bacterial,diptheria,tb
Cause : (cont..)
Cause : (cont..)
4. Trauma : - Post intubation - Iatrogenic post surgical - Burn trauma inhalation - External blunt or sharp
Cause : (cont..)5. Tumor : - Benign : papilloma, haemangioma - Malignancy : laryngeal carcinoma
Cause : (cont..)
6. Bilateral abductor paralysis of the vocal cord - Complication of thyroid surgery
- Neck trauma blunt, penetrating in juries - Malignancy in neck or mediastinum
- Central nervous system disease - Idiopatic
Diagnostic
- Clinical features- Blood gas analysis (astrup)- Direct laryngoscopy (if posible)- Flexible fibreoptic laryngoscopy- X-ray lateral soft tissue (neck)- Computed tomografi- Magnetic resonance Imaging (MRI)
Management
• Principally effort to achieve normal upper airways passage.• Conservatif Jackson Std 1 - O2 - Steroid < laryng oedem - AB < infection - Antiinflamation drug
Management (cont..)
• Surgical Depend on cause • Upper Airways Obstruction (Jackson Std 2 – 4) Important live saving procedure :
Emergency Management of Upper Airway Obstruction
Live saving procedure : - Intubation - Cricothyrotomy (not recomended in neonatal and
children - Tracheostomy
Cricothyrotomy
• Indication:– Complete upper airway obstruction
unmanageable by intubation in adult patient.– Standard tracheostomy is not possible.– Unstable cervical spine fracture complicated
by airway difficulties where extension of the neck for tracheostomy may cause nerve injury.
• Contra indication: not recommended for children
Advantages
• Extremely rapid control of oxygenation and ventilation.
• Requires minimal technical expertise.
• Possible to be performed in any position (including the sitting position).
• No special instrument was needed (possible to be performed in any place).
Procedure
Tracheostomy / Tracheotomy
Definition:
The procedure to make a temporary opening in the anterior neck into the trachea, which air may pass to the lungs bypassing the upper airway.
Indication
1. Upper airway obstruction caused by:a. Infection: Ludwig’s Angina, retropharyngeal abscess,
diphtheria.
b. Inflammation: acute laryngitis, gas or corrosive inhalation, drug reaction.
c. Trauma: laryngotracheal trauma.
d. Laryngotracheal stenosis.
e. Tumor: oropharynx and larynx.
f. Vocal cord paralysis.
Indication
2. Respiratory insufficiency: a. Eliminates upper respiratory dead space.
b. Decreases the upper airway resistance & CO2 retention.
Indication
3. Prolonged intubation: conversion to tracheostomy are:
a. To manage accumulation secretion.
b. To prevent the complication such as sinusitis, OME (nasal intubations), mucosal & cartilage destruction and laryngeal or subglottic stenosis.
c. To minimized daycare in the ICU.
Indication
4. Ineffective mucous clearance due to: a. Loss of cilia.
b. Fractured ribs, unwillingness to cough because of pain.
c. CNS injury.
d. Coma.
e. Vegetative stage.
Indication
5. Elective surgery with difficulty to intubation.
6. Prevent airway obstruction in the head & neck cancer patient who will undergo radio or chemotherapy.
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